Chiindi Jamana a banker at Indo Zambia bank complains of dizziness on standing up from his office seat when he noted you are wearing a T shirt for LMMU Doctors. He reports episodes of fainting a year ago. He is unable to play soccer or run. He reports hea

### a. Comment on the Pulse Pressure (5 marks) The pulse pressure is calculated as the difference between the systolic and diastolic blood pressure values. In this case: Pulse Pressure = Systolic BP - Diastolic BP Pulse Pressure = 134 mmHg - 45 mmHg = 89 mmHg A normal pulse pressure is typically around 40 mmHg. A pulse pressure of 89 mmHg is considered wide or elevated, indicating a significant difference between systolic and diastolic pressures. This may suggest an underlying health issue. A wide pulse pressure can be associated with conditions such as aortic regurgitation, arteriosclerosis, or hyperthyroidism. In this context, Chiindi’s symptoms of dizziness on standing and episodes of fainting could relate to cardiovascular instability or other systemic vascular issues. ### b. Calculate the Mean Arterial Pressure and Make a Comment (5 marks) Mean Arterial Pressure (MAP) can be estimated using the formula: \[ \text{MAP} = \text{DBP} + \frac{1}{3}(\text{SBP} - \text{DBP}) \] Using the provided blood pressure values: \[ \text{MAP} = 45 mmHg + \frac{1}{3}(134 mmHg - 45 mmHg) \] \[ \text{MAP} = 45 mmHg + \frac{1}{3}(89 mmHg) \] \[ \text{MAP} = 45 mmHg + 29.67 mmHg \] \[ \text{MAP} ≈ 74.67 mmHg \] A MAP of approximately 74.67 mmHg is on the lower side of the normal range (typically considered normal if around 70-100 mmHg). This low MAP could contribute to Chiindi’s symptoms of dizziness and fainting because it suggests reduced perfusion to vital organs, particularly in the context of standing up, which may exacerbate orthostatic intolerance. ### c. List the Abnormality(ies) That Can Cause This Problem (5 marks) Several medical conditions can lead to a wide pulse pressure and the symptoms Chiindi presents. Possible abnormalities include: 1. **Aortic regurgitation**: A condition where the aortic valve does not close properly, leading to volume overload and a wide pulse pressure. 2. **Arteriosclerosis**: General stiffening of arteries can lead to an increase in systolic blood pressure with a relatively low diastolic pressure, contributing to a wider pulse pressure. 3. **Hyperthyroidism**: Increased metabolic state can result in increased heart rate and decreased vascular resistance, potentially leading to wide pulse pressure. 4. **Severe anemia**: Can cause hemodynamic changes leading to a discrepancy between systolic and diastolic pressures. 5. **Autonomic dysfunction (e.g., postural orthostatic tachycardia syndrome - POTS)**: This may lead to impaired blood vessel response and distort normal blood pressure responses during changes in body position. In conclusion, the presented symptoms alongside the blood pressure parameters indicate a possible cardiovascular abnormality requiring further investigation.